<div id="recertstep3" style="display:none;">
	<cfform name="formstep3" id="formstep3">
		<div class="form-body">
			<div class="margin-top-10 text-center">
				<ul class="pagination nav_pagination" style="margin:0;">
					<cfloop index=ind from="1" to="9">
						<cfoutput>
							<li class="nav_recertstep#ind# <cfif ind eq 1>active</cfif>" onClick="$('##recertstep3').hide(); $('##recertstep#ind#').show(); $('.pagination li').removeClass('active'); $('.nav_recertstep#ind#').addClass('active');">
								<a href="javascript:;">#ind#</a>
							</li>
						</cfoutput>
					</cfloop>
				</ul>

				<div class="dashboard-stat2 progress_div" style="margin: 0px auto; padding-top: 0px; max-width: 320px;">
					<div class="progress-info">
						<div class="progress" style="height: 9px">
							<span class="progress-bar progress-bar-success green-sharp">
								<span class="sr-only ">0% progress</span>
							</span>
						</div>
						<div class="status">
							<div class="status-title"> progress </div>
							<div class="status-number"> <span class="progressBar">0%</span> </div>
						</div>
					</div>
				</div>
			</div>
			<div class="well">
			<input type="hidden" name="Woundid" id="Woundid"/>
			<div class="form-group">
				<div class="label-stable">
					<label>M1200 Vision (with corrective lenses if the patient usually wears them)</label>
					<div id="drpM1200d" class="radio-list">
						<label>
						<input type="radio" name="drpM1200" value="0 - Normal vision: Sees adequately in most situations; can see medication labels, newsprint" <cfif Recertform.Vision_M0390 contains "0">checked</cfif>> Normal vision: Sees adequately in most situations; can see medication labels, newsprint</label>
						<label>
						<input type="radio" name="drpM1200" value="1 - Partially impaired: cannot see medication label or newsprint but can see obstacles on path" <cfif Recertform.Vision_M0390 contains "1">checked</cfif>> Partially impaired: cannot see medication label or newsprint but can see obstacles on path</label>
						<label>
						<input type="radio" name="drpM1200" value="2 - Severely impaired: cannot locate objects without hearing or touching them or patient nonresponsive" <cfif Recertform.Vision_M0390 contains "2">checked</cfif>> Severely impaired: cannot locate objects without hearing or touching them or patient nonresponsive</label>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>M1242 Frequency of Pain Interfering with patient's activity or movement</label>
					<div id="m1242d" class="radio-list">
						<label>
						<input type="radio" name="m1242" value="0 - Patient has no pain" <cfif Recertform.Freq_of_Pain_M0420 EQ "0 - Patient has no pain">checked </cfif>/> 0 - Patient has no pain</label>
						<label>
						<input type="radio" name="m1242" value="1 - Patient has pain that does not interfere with activity or movement"<cfif Recertform.Freq_of_Pain_M0420 EQ "1 - Patient has pain that does not interfere with activity or movement">checked </cfif>/> 1 - Patient has pain that does not interfere with activity or movement</label>
						<label>
						<input type="radio" name="m1242" value="2 - Less often than daily"<cfif Recertform.Freq_of_Pain_M0420 EQ "2 - Less often than daily">checked </cfif>/> 2 - Less often than daily</label>
						<label>
						<input type="radio" name="m1242" value="3 - Daily, but not constantly"<cfif Recertform.Freq_of_Pain_M0420 EQ "3 - Daily, but not constantly">checked </cfif>/> 3 - Daily, but not constantly</label>
						<label>
						<input type="radio" name="m1242" value="4 - All of the time"<cfif Recertform.Freq_of_Pain_M0420 EQ "4 - All of the time">checked </cfif>/> 4 - All of the time</label>
					</div>
				</div>
			</div>
			<div class="row">
				<div class="col-md-6">
					<div id="divpainass">
						<div class="form-group">
							<div class="label-stable">
								<label>Pain Assessment</label>
								<div class="checkbox-list">
									<label>
									<input type="checkbox"  name="painlevel" value="pain level 0 (low)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 0 (low)">checked </cfif> /> pain level 0 (low)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 1 (low)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 1 (low)">checked </cfif> /> pain level 1 (low)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 2 (low)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 2 (low)">checked </cfif> /> pain level 2 (low)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 3(med)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 3(med)">checked </cfif> /> pain level 3 (med)</label>
									<label>
									<input type="checkbox"  name="painlevel" value="pain level 4 (med)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 4 (med)">checked </cfif> /> pain level 4 (med)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 5 (med)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 5 (med)">checked </cfif> /> pain level 5 (med)</label>
									<label>
									<input type="checkbox" name="painlevel"  value="pain level 6 (med)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 6 (med)">checked </cfif> /> pain level 6 (med)</label>
									<label>
									<input type="checkbox"  name="painlevel" value="pain level 7(high)" onclick="changebg('painlevel','txtpainlevel','divpainass');"  <cfif Recertform.M0420_Assess Contains "pain level 7(high)">checked </cfif> /> pain level 7 (high)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 8 (high)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 8 (high)">checked </cfif> /> pain level 8 (high)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 9 (high)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 9 (high)">checked </cfif> /> pain level 9 (high)</label>
									<label>
									<input type="checkbox" name="painlevel" value="pain level 10 (high)" onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess Contains "pain level 10 (high)">checked </cfif> /> pain level 10 (high)</label>
									<label>
									<input type="checkbox" name="painlevel" value="Other"  onclick="changebg('painlevel','txtpainlevel','divpainass');" <cfif Recertform.M0420_Assess NEQ "">checked</cfif> /> Other...</label>
								</div>
							</div>
							<cfoutput><textarea class="form-control" name="txtpainlevel" id="txtpainlevel" style="display:none;">#Recertform.M0420_Assess#</textarea></cfoutput>
						</div>
					</div>
				</div>
				<div class="col-md-6">
					<div class="form-group">
						<div class="label-stable">
							<label>Skin Assessment</label>
							<div id="divskin" class="checkbox-list">
								<label>
								<input name="color" type="checkbox" value="Poor skin turgor"  onclick="changebg('color','txtSkinOther','divskin');" <cfif Recertform.M0440_Assess Contains "Poor skin turgor">checked</cfif>/> Poor skin turgor</label>
								<label>
								<input type="checkbox" name="color" value="Color pale"  onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains "Color pale">checked</cfif>> Color pale</label>
								<label>
								<input type="checkbox" name="color" value="Color jaundice" onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains "Color jaundice">checked</cfif>/> Color jaundice</label>
								<label>
								<input type="checkbox" name="color" value="Color cyanotic" onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains "Color cyanotic">checked</cfif> /> color cyanotic</label>
								<label>
								<input type="checkbox" name="color" value="Sweaty skin" onclick="changebg('color','txtSkinOther','divskin');" <cfif Recertform.M0440_Assess Contains "Sweaty skin">checked</cfif>/> Sweaty skin</label>
								<label>
								<input type="checkbox" name="color" value="Dry skin" onclick="changebg('color','txtSkinOther','divskin');" <cfif Recertform.M0440_Assess Contains "Dry skin">checked</cfif>/> Dry skin</label>
								<label>
								<input type="checkbox" name="color" value="Bruise(s)" onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains "Bruise(s)">checked</cfif>/> Bruise(s)</label>
								<label>
								<input type="checkbox" name="color" value="Rash(es)" onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains "Rash(es)">checked</cfif> /> Rash(es)</label>
								<label>
								<input type="checkbox" name="color" value="Asymptomatic" onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains "Asymptomatic">checked</cfif>/> Asymptomatic</label>
								<label>
								<input type="checkbox" name="color" value="Other" onclick="changebg('color','txtSkinOther','divskin');"<cfif Recertform.M0440_Assess Contains " ">checked</cfif>/> Other...</label>
							</div>
						</div>
						<cfoutput><textarea class="form-control" id="txtSkinOther" name="txtSkinOther" style="display:none;">#Recertform.M0440_Assess#</textarea></cfoutput>
					</div>
				</div>
			</div>
			<table class="margin-bottom-20" border="0" cellpadding="0" cellspacing="0" style="width:100%; text-align:center;">
				<tr>
					<td><img src="../../images/smily0.gif" /></td>
					<td><img src="../../images/smily2.gif"/></td>
					<td><img src="../../images/smily4.gif" /></td>
					<td><img src="../../images/smily6.gif"/></td>
					<td><img src="../../images/smily8.gif" /></td>
					<td><img src="../../images/smily10.gif"/></td>
				</tr>
				<tr>
					<td>0</td>
					<td>2</td>
					<td>4</td>
					<td>6</td>
					<td>8</td>
					<td>10</td>
				</tr>
			</table>
			
			<p class="btn blue margin-bottom-20" id="lowRiskSkin" style="cursor:pointer;" onclick="$('#braden_scale').modal('show');">
				<span id="spnBraden1">
					<cfif left(Recertform.Braden_1_Sensory,1) NEQ "" OR
						left(Recertform.Braden_2_Moisture,1) NEQ "" OR
						left(Recertform.Braden_3_Activity,1) NEQ "" OR
						left(Recertform.Braden_4_Mobility,1) NEQ "" OR
						left(Recertform.Braden_5_Nutrition,1) NEQ "" OR
						left(Recertform.Braden_6_Friction,1) NEQ "">
						<cfif PressureRate LTE 12>
							HIGH RISK
						<cfelseif PressureRate EQ 13 OR PressureRate EQ 14 >
							MODERATE RISK
						<cfelseif PressureRate GTE 15>
							LOW RISK
						</cfif>
						for Pressure Ulcers
					<cfelse>
						Braden Scale incomplete click to edit
					</cfif>
				</span>
			</p>
			<p class="btn blue margin-bottom-20" id="Lnkwound" onclick="WoundClick();" style="cursor:pointer;">
				<span id="spnwound1"><cfoutput>#cookie.WoundCount#</cfoutput></span>  wounds - click to edit
			</p>
			
			<div class="hidden">
			<div class="form-group">
				<div class="label-stable">
					<label>Use Wound AutoFill? <img src="../../images/icon_help.png" alt="top" style="cursor:pointer" onclick="helpSkin();" /></label>
					<div id="spanWoundAutofil1" class="checkbox-list">
						<label>
						<input type="checkbox" name="chkM1010Yes" onclick="woundchkYes('1')" value="Yes"> Yes</label>
					</div>
				</div>
			</div>
			</div>
			
			
			<div class="form-group">
				<div class="label-stable">
					<label>M1306 Does this patient have at least one Unhealed Pressure Ulcer at Stage ll or Higher or designated as "unstageable"?</label>
					<div id="0unhealedd" class="radio-list">
						<label>
						<input type="radio" name="0unhealed" value="0 - No" <cfif Recertform.M1306_Unhealed_Pressure EQ "0 - No">checked</cfif>> <span id="spn0unhealed1">0 - No</span></label>
						<label>
						<input type="radio" name="0unhealed" value="1 - Yes"<cfif Recertform.M1306_Unhealed_Pressure EQ "1 - Yes">checked</cfif>> <span id="spn0unhealed2">1 - Yes</span></label>
					</div>
				</div>
			</div>
			<div class="form-group">
				<label>Comments</label>
				<textarea class="form-control" name="txtComment" id="txtComment" onblur="CommentChangeBlur('formstep3')" rows="3"><cfoutput>#Recertform.Assessment_note#</cfoutput></textarea>
			</div>
			<div class="form-group">
				<label>Add Vital <img name="imgbtnaddvital" id="imgbtnaddvital" src="../../images/icon_add.png" style="cursor:pointer" onclick="$('#Vitaldiv').modal('show');"/></label>
			</div>
		</div>
		</div>
		
		<div class="form-actions">
            <input class="btn blue" type="button" value="Previous" onClick="$('#recertstep3').hide(); $('#recertstep2').show(); $('.pagination li').removeClass('active'); $('.nav_recertstep2').addClass('active'); $('html, body').animate({scrollTop: '0px'}, 300);">
            <input class="btn green" type="button" value="Next" onClick="return shownextwindow('3','');">
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